Update on Nigeria Polio Transition Planning Process NIGERIA - - PowerPoint PPT Presentation

Update on Nigeria Polio Transition Planning Process

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NIGERIA Transition Independent Monitoring Board London 4 May 2017

Nigeria Polio Transition Technical Task Team(PT4)

Outline

• Background
• Transition planning update
• Next steps
• Challenges identified
• Support needed

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Background

• Nigeria recently reclassified as

Polio Endemic Country following the recent outbreak in Borno state of Nigeria after almost 2 years of being Polio Free

• Currently implementing a

robust outbreak response plan along side a country Polio Transition plan

• Risks of Double transition in

context with both GPEI and GAVI transitioning occurring within the same time frame

Nigeria Polio Transition Technical Task Team(PT4) 3

29 58 202 355 792 830 1122 286 796 388 21 62 122 53 6 4 200 400 600 800 1000 1200 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Transition Planning Update

4 4 S/N Position/committee Membership Key function 1 Inter-agency Coordination Committee (ICC) Government and Partner Agencies Chaired by the Honourable Minister of Health

• General oversight on Health Policy

2 National Polio Legacy Planning Committee (NPLPC)

• Inaugurated 18 May 2016

Federal Ministries of Health; Finance; & Budget and Planning; National Primary Health Care Development Agency (NPHCDA); and Partners Chaired by the Executive Director, NPHCDA

• Provide policy direction and supervisory oversight
• n polio transition planning activities
• Mobilize needed resources for implementation of

legacy work plan

• Review and approve/endorse all PT4 submissions.

3 Polio Transition Technical Task Team (PT4)

• Inaugurated 18 May 2016

NPHCDA and Partners Chaired by the National Coordinator , Polio Legacy Planning PT4 Secretariat: NPHCDA; WHO; UNICEF; and CHAI

• Finalize mapping of all Polio assets in Nigeria
• Develop a clear costed work and decision-making

framework

• Implement polio transition planning work plan in

line with agreed time frames and provide regular updates

 Governing and management team established

National Coordinator for Polio legacy was appointed in April 2016

Agency No of Personnel Annual Standard cost USD CDC 6 $2,050,000.00 CGPP 1967 $954,580.00 NSTOP 241 $7,222,800.00 UNICEF 17927 $26,247,480.83 WHO 2908 $51,812,006.13 NPHCDA/FMOH 220 $1,300,175.84 Grand Total 23269 $89,587,042.79

The summary of the Personnel cost averages per annum across all the implementing Partners in Nigeria stands at $89,587,042. This covers functions across the 10 program areas and distributed across the 36+1 states as well as central level staffs. However, 98% of these personnel are located in the 11 Polio high risk states as shown below and account for about 70% of the total personnel cost.

 completed

* 121,413 personnel are recruited as Polio team members across country for

every National Campaign with a personnel cost of $9 Million(Funded through WHO) Nigeria Polio Transition Technical Task Team(PT4) 5

Asset Mapping

Large physical assets (Office presence in all Zones/States)

NCZ NEZ NWZ SEZ SSZ SWZ

HR distribution by zone

North Central Zone 6% North Western Zone 65% NorthEastern Zone 28% South Eastern Zone 0% South South Zone 0% South West Zone 1%

HR and Physical Assets Mapping

Polio Personnel by Level of Implementation/Partner

Agency Country Zone State LGA Ward Community Grand Total CDC 6 6 CGPP 36 19 29 188 1695 1967 NPHCDA/F MOH 220 220 NSTOP 241 241 UNICEF 20 10 140 441 1256 16060 17927 WHO 73 36 425 504 1610 260 2908 Grand Total 355 46 584 1215 3054 18015 23269

Nigeria Polio Transition Technical Task Team(PT4) 7

5.2% 55.4% 13.1% 86.2% 89.6% 77.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% CDC CGPP NPHCDA/FMOH NSTOP UNICEF WHO NIGERIA Country Zone State LGA Ward Community

77.4% of all polio staff are located at the community level.89.6% and 86.2% of UNICEF and CGPP personnel are at the community level, while NSTOP are at the LGA(District) and CDC at the Country Level. WHO staff spread mainly at the Ward(55.4%,LGA(17.3%) and State(14.3)% Levels

Polio personnel contribution to other programs

• To document this contribution, a

survey was conducted using the WHO ODK platform in December 2016

• Personnel of WHO,UNICEF and Govt

were asked to fill a questionnaire stating their activity allotments in the field, qualifications, No. of years involved in PEI etc.

• 718 personnel responded to the

survey mainly at National, state levels

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0.28% 16.57% 83.15% NPHCDA UNICEF WHO

50 100 150 200 250 0-5Years 6-10Years 11-15Years 16-20Years >20Years

Number of Staff by years of Experience

Staff time involvement by polio Sub-Functions

43% 38% 47% 54% 69% 46% 15% 61% 37% 68% 1% 52% 47% 41% 19% 35% 61% 15% 37% 11% 46% 23% 11% 8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Cold Chain Management_Logistics Other Vaccine Management Central Support and Planning of… Activities and Campaign Field Supervisors of Immunization… Outbreak and Emergency Planning Security Planning Data Analysis and Reporting Monitoring and Evaluation Surveillance Officers Lab Technicians and Testing Planning Social Mobilizers Other types of Community Engagement Media, Communications and Advocacy Technical Expertise Training Financial Mobilization Resource Mobilization Research Partnership and Coordination General Management General Administration General Operations(e.g drivers)

88% 27% 63% 11% 16% 74% 76% 68% 13% 13% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Routine Immunization Sanitation and Hygiene Maternal and Neonatal child Health HIV/AIDs Aids, TB & Malaria (ATM) Disease Outbreak Response/IDSR Measles New Vaccines Introduction Crises/Humanitarian Support OTHERS

Source:PT4 Survey of National Polio Personnel(N=718

Polio personnel Time spent on Non Polio programmes

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Best Practices Compendium Nigeria

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• 1. PHC Revitalization
• Improve availability, quality and redistribution of human resources for health.
• Strengthen logistics and supply cold chain management
• Strengthen referral systems
• Improve management support and oversight
• Strengthen health facility infrastructural maintenance
• Promote innovation and use of technology to improve health services
• Improve community ownership and participations to improve demand for and quality of health services and ensure

accountability through the Ward Development Committee(WDCs

• 2. Expanded Program on Immunization/Routine Immunization
• Increase and sustain routine immunization coverage for all antigens and reduce morbidity and mortality form VPDs
• Reach the hard to reach LGAs/Communities
• Sustain availability of bundled vaccines at service delivery sites
• Introduce new and underutilized vaccines (PCV, Rotavirus, HPV and IPV) into the country’s immunization schedule
• Strengthen health management information system(HMIS)
• Strengthen the PHC system(through wards/community structure and participation
• Improve budgeting and budget execution at Federal, State, LGA and ward levels
• Sustain and expand the cold chain at all levels
• Sustain interruption of WPV transmission and eradication of Polio
• Measles mortality and morbidity reduction
• Maternal and neonatal tetanus elimination
• 3. Disease Surveillance and Response/Emergencies
• AFP Surveillance:
• Case detection and reporting,
• Sample collection, handling and transportation.
• Laboratory network support and Quality assurance and control/QC.
• Laboratory Certification, environmental surveillance.
• Sero-surveillance
• Community surveillance network.
• Expanded support of these laboratory for other disease confirmation in terms of disease outbreaks
• Accelerated disease control: Support surveillance for measles, Yellow Fever, cerebrospinal meningitis, Neonatal tetanus
• IDSR current structure: strengthen reporting timeliness and quality, disease outbreak investigation and response.
• Emergency response coordination

National Health Priorities identified

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2 day Polio Transition Simulation Exercise held & Transition Strategies identified  Det Deter ermining mining Transit ansition ion Str Strate tegies gies

Participants included 74 participants from approximately 30 agencies and

• rganizations

representing key government agencies at Federal and state levels; partner agencies and stakeholders; and representatives from the Polio specialized laboratories; and from the Northern Traditional Leaders Committee. Outcomes from the simulation exercise  Criticality of polio functions as it affects directly or indirectly the National Health Priority areas documented.  Opportunities for polio assets and functions to support the implementation of national health priorities identified.  General transition strategies to ensure that polio assets and functions are leveraged to contribute to these health priorities suggested.  Review of practicality of the recommended transition strategies and assessment of budgetary implications, towards addressing gaps ongoing.

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Suggested transition strategies by thematic area

14 5 10 15 20 25 Transfer responsibility for conduction essentioal polio function to Government Maintain Minimum assets and Structure Build Local Capacity to take over Management and Implementation while phasing out Polio program assets Transfer responsibility to an alternate implementing partner/New Organization Maintain Polio program and assets for

• ther health Priorities

Discontinue Polio function Discontinue Polio Functiona and Sunset assets Discontinue Assets/Functions but ensure lessons learnet are intergrated into other health programs PHC EPI/RI Disease surveillance/Outbreak response

Linking GAVI transition With Polio Transition Plan

Once a GAVI country’s GNI per capita > US$1,580, it enters graduation and must step up its co-financing amounts over the next 5-7 years:2012-2014 3 Year average was $2380)

Preparatory Transition 15% annual increase in co-financing reqs. (based on antigen price) Accelerated Phase 2 Increasing country co-financing requirements over 5 years* Transitioned Country fully financing RI & NVI, with access to Gavi prices for 5 years post-transition Country enters graduation Initial Self- Financing $0.20/dose co- financing for all Gavi vaccines

*May be extended to 7 years in certain cases (e.g. unexpected rebasing of Nigeria’s GDP)

GPEI Vs GAVI Transition

Nigeria Polio Transition Technical Task Team(PT4) 17

2015 2016 2017 2018 2019 2020 2021 2022 2023 GAVI TRANSITION GPEI TRANSITION

Polio Transition Plannng Transition Plan Implementation

Transition plan Implementation Extension

Post Certification Stategy Preparatory Trasnition (Phase 1) Accelerated Transition(Phase 2) Fully Trasitioned (Phase 3)

Biggest Risk for GAVI transitioning is perceived effect on vaccine procurement and Cold chain Management. Country engagement framework development meetings scheduled for Q2&Q3 2016.PT4 will be part of these engagement GAVI HSS grants utilization for system strengthening.

Country engagement framework

This will focus of about 6 main thematic areas focus or linking PTP will be:

• 1. The plan is to have an integrated disease surveillance reporting

in the country by 2020, coordinated by the Nigeria Centre for Disease control(NCDC) 2. Plan to fully transition from DVD-MT to DHIS2 by January 2019. DHIS2 has been rolled-out in the country in a phased manner in the country; and to be completed by Dec 2018. 3. The monthly DHIS2 reporting would cover the following areas: immunization coverage, utilization and surveillance; 4. Under the PHC revitalization, efforts are on-going to support expansion of laboratories / supplies of needed materials for basic diagnosis of some of the VPDs.

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Next Steps

• 1. Business Case Development

I. Interactive meetings with relevant stakeholders at subnational Levels ( states and LGAs) II. Engagement of consulting Firm

• 2. Initiate and finalize alignment of polio transition plan

with GAVI Transition plan through the Country engagement framework

• 3. Endorsement of the Business Case by the relevant

Stakeholders.

• 4. Development of draft National Polio Transition

Plan(PTP) with timeliness and robust M&E framework

• 5. Endorsement of the PTP by Government and Partners

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Challenges Identified

• 1. Outbreak of Wild Polio Virus in Borno state, Nigeria

I. Destabilizing effect on the polio transition Agenda II. Prioritizing the OBR and its impact on transition planning personnel participation

• 2. Funding Gaps in Transition Plan Process
• 3. Communicating and finalizing transition strategies

endorsement with specifics from Partners and Government department

• 4. Achieving consensus and buy-in amongst the three

tiers of government in Nigeria

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Support Needed

• 1. Support in engagement of consultant/Consulting

Firm for business case development

• 2. Continued communication between

GPEI/TMG/Regional and Nigeria Polio Transition team

• 3. Funding Support: Gaps in National Transition

planning work plan

• 4. High level advocacy and engagement on Transition

planning

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THANK YOU

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